Monday, February 27, 2006

Underserved in America

Sometimes, I get too wrapped up in big issues, such as universal health
coverage, or in minutiae, such as neurochemistry, and lose sight of the
middle picture. In the service of my endless pursuit for
balance, I am going to look at a couple of the mid-scale issues in
health care today.

The Los Angeles Times today has an article about the state of mental
health care for children and adolescents in the USA. A while
back, I wrote that the undersupply of qualified mental health care
professionals serving children is a national disgrace. The
LAT confirms that this has not changed.

Young
and alone
With only 7,500 child psychiatrists in the U.S., millions who need
treatment are left desperate for care.By Shari Roan, Times Staff Writer
February 27 2006

[...] When they need help the most, some families find, they're on
their own.

"It would be the equivalent of your child getting a concussion, in
pain, vomiting, and not being able to get any medical help," says
Sandra Betler, an Orange County woman whose daughter began cutting
herself and talking of suicide last spring but who couldn't find a
doctor to see her child. "You think they're going to die at any time."

About 15 million U.S. children ages 9 to 17 are thought to have a
serious mental or addictive disorder — such as depression,
anxiety, attention deficit hyperactivity disorder (ADHD), eating
disorders, early onset schizophrenia or bipolar disorder. [...]

But only about 7,500 child psychiatrists are currently practicing in
the United States — and only 300 new child and adolescent
psychiatrists complete training each year. The profession —
the
only board-certified medical specialty that trains physicians to treat
mental disorders in children and teens — is experiencing one
of
the most severe labor shortages among all medical specialties.Those doctors who are available are
often concentrated in
urban areas, leaving some rural counties without a single child
psychiatrist.

"Every child psychiatrist in the country has a waiting list," says
Fritz, an expert on the workforce shortage. "I've never talked to one
who didn't. Many will not even put people on a waiting list because
it's too long and ridiculous." [...]

This situation is made worse by the fact that some psychiatrists finish
their residency, do a fellowship in child psychiatry, then go into
practice in which they see only adults. I've never been sure
why that is, and it would be presumptuous of my to make some kind of
negative judgment about that, but it is important to realize that not
all of the 300 new child psychiatrists each year will actually see
children.

Personally, I would guess that one of the reasons that some child
psychiatrists do not see children, is the same reason that I chose to
not do a child fellowship. That is, in addition to the USA
having a shortage of child psychiatrists, there also is a shortage of
nonmedical child service providers: therapist, social workers, child
protection workers, foster care homes, special education teachers, etc.
I thought is would be endlessly disheartening to try to
function in that system.

As an aside, I would like to point out that there is no easy answer to
this. Increasing the supply of child psychiatrists without
also increasing the supply of the other child workers would necessarily
lead to an overemphasis on medication treatment, to the exclusion of
psychosocial interventions. It is pretty obvious that if a
kid is neglected or abused at home, underserved in school, hungry, and
otherwise disadvantaged, putting the kid on a medication is not going
to do a whole lot of good.

The
whole topic is depressing. Sometimes, though, there are some
points of light amid the gloom.

This week happens to be National
Eating Disorder Awareness Week. (HT: Dr. Serani).
Eating Disorders often start in childhood or adolescence, and
as a result, tend to be underrecognized and undertreated.
The "awareness week" activities can help. Every once in a
while, people participate in these kinds of activities, and as a
result, end up going ahead and seeking a proper evaluation.
Sometimes they don't seek help right away, but end up doing
so after a few days or weeks.

In cases of eating disorders, quicker treatment can make a big
difference. Some persons with eating disorders develop
serious medical complications. The risk increases with time.
Therefore, quicker treatment can mean fewer complications.

Another benefit from awareness week events is that they can help
educate the general public. This may reduce stigma, which is
always a good thing. It also may help persons who know
persons with eating disorders to become more understanding.
One of the problems that faces a person with an eating
disorder is the sense of isolation -- even alienation -- that can
accompany the disorder. The more people understand the
problem, the better.

The link below goes to a dummy account that automatically forwards email to the Federal Trade Commission's spam reporting service. Don't use it unless
you are a robot. Instead, act like a human and figure out the real address from this: joseph/dot/j7uy5/at-sign/gmail/dot/com

The Corpus Callosum is an occasional journal of armchair musings, by an Ann Arbor reality-based, slightly-left-of-center regular guy who reserves the right to be highly irregular at times.
Topics: social commentary, neuroscience, politics, science news.
Mission: to develop connections between hard science and social science, using linear thinking and intuition; and to explore the relative merits of spontaneity vs. strategy.